Predictors of declining self-rated health during the transition to menopause

https://doi.org/10.1016/S0022-3999(02)00415-4Get rights and content

Abstract

Objective: To determine factors associated with declining self-rated health as measured annually for 8 years in a prospective population-based cohort of middle-aged Australian-born women. In particular, to investigate the potential role of the menopausal transition in changing self-rated health. Methods: A total of 262 women from the Melbourne Women's Midlife Health Project were asked to rate their present health compared with other women about the same age as worse than, the same as or better than most. Results: Women reporting their health to be “better than most” decreased from 51.2% at Year 1 to 41.3% at Year 8. In the year prior to the late menopausal transition, women reporting their health to be ‘better than most’ declined by 5%. Comparing women who experienced the menopausal transition with women whose menopausal status did not change, there was no significant difference in changes in self-rated health. Change in body mass index (OR=1.53; 95% CI=1.13 to 2.06) and change in feelings for partner (OR=0.38; 95% CI=0.17 to 0.86) predicted a change in self-rated health from a baseline status of ‘better than most.’ Having an operation or procedure in the last year (OR=8.63; 95% CI=1.84 to 40.4) and an increase in the number of symptoms (OR=1.32; 95% CI=1.01 to 1.72) predicted a decline in self-rated health from baseline status of ‘same as others.’ Conclusion: This prospective study found a small decline in self-rated health with age but no significant effect of the menopausal transition. Different factors relate to differing self-rated health groupings. Further studies involving other ethnic groups and larger sample sizes are needed.

Introduction

There has been much concern about the effect of the menopausal transition on quality of life. An important component of quality of life is undoubtedly health status. Self-rating of health, a global assessment by an individual, has been shown to be a significant predictor of the use of health services [1] and of mortality [2]. Self-rated health is a complex construct which is affected by both medical and socio-cultural factors. Utilising an assessment question anchored to the health of one's peers, we have previously shown that health perceived worse than one's peers was largely a reflection of the physical experience of ill-health, whereas better self-rated health was a more complex construct incorporating social factors, as well as absence of ill-health [3]. That analysis utilised the baseline data of a prospective population-based study of women's experience of health during midlife. As such, the study was able to identify factors correlated with different categories of self-rated health but suffered from the disadvantages present in cross-sectional studies. Cross-sectional studies can neither identify the direction of causality nor take into account the often powerful effect of baseline levels of determinants [4]. Such studies are not able to disentangle the effect of age from that of changes in menopausal status, which reflect underlying hormonal changes. These studies are less satisfactory than longitudinal studies in which the same women are being followed over time with the same instruments so that what is being observed is change in the same population with time. Longitudinal cohort designs facilitate the identification of those associations most likely to reflect a cause–effect relationship and can potentially separate the effects of aging from those of menopause [5]. Longitudinal collection of data reduces reliance on memory for long recall periods, which can lead to further inaccuracy of data. This is not only true for the studied endpoints, but also for possible covariates at the time of occurrence. In longitudinal studies, there is the opportunity for measures to be made prospectively (such as menstrual diaries) rather than relying on self-recall, which may be substantially less accurate. When change over time is the key concern, a prospective design is mandatory [6].

The aim of the present study was to determine the factors associated with declining self-rated health as measured annually for 8 years in the Melbourne Women's Midlife Health Project, a prospective population-based cohort of middle-aged Australian-born women. A major focus of the analysis was to investigate the potential role of the menopausal transition in changing self-rated health.

Section snippets

Subjects

The study began in 1991 using random telephone digital dialing to obtain a baseline interview from 2001 Australian-born women aged between 45 and 55 years and residing in Melbourne (71% response rate) [7]. All women at baseline who had experienced menses in the prior 3 months, and who were not taking the oral contraceptive pill or hormone therapy, were invited to participate in a longitudinal study. Of those eligible, 438 (56%) chose to do so. Volunteers for the longitudinal study were more

Results

The average (S.D.) age at baseline of the 262 women was 48.8 (2.4) years, range 45–55; 81% were married or living with a partner, 37% had more than 12 years of education, and 72% were in paid employment.

Fig. 1 shows the percentage distribution of self-rated health by study year. The percentage of women reporting their health to be “better than most” decreased from 51.2% at Year 1 to 41.3% at Year 8, representing a decline of −9.9% (95% CI=18.7% to −1.1%, P<.05), or −1.2% per annum. The

Discussion

This study found a small and continuing decline in perception of health with increasing age. When self-rated health was centred on first reporting of prolonged amenorrhoea (late menopausal transition status), there appeared to be a small association. However, when the study group of women who passed through the menopausal transition were compared with the two smaller subgroups derived from the same population sample whose menopausal status remained the same, no statistically significant effect

Conclusions

This prospective study found a continuing small decline in self-rated health with aging but no significant effect of the menopausal transition. The study confirms our earlier findings that different factors relate to differing self-rated health groupings. Changing psychosocial factors have more impact on those women who at baseline self-rated their health as better than most, whereas those whose health was rated at baseline as the same as others were more negatively impacted by the physical

Acknowledgements

This study was supported by grants from the Victorian Health Promotion Foundation and the Public Health Research and Development Committee of the Australian National Health and Medical Research Council. In 2001, grant-in-aids were received from Pharmacia and Upjohn and ANZ Trustees. We thank Mr. Nick Balazs and the staff of the Department of Biochemistry at Monash Medical Centre for the hormone assays.

References (24)

  • L Dennerstein et al.

    Factors contributing to positive mood during the menopausal transition

    J Nerv Ment Dis

    (2000)
  • N Avis et al.

    The Massachusetts Women's Health Study: an epidemiologic investigation of the menopause

    J Am Med Women's Assoc

    (1995)
  • Cited by (34)

    • Hot flashes severity, complementary and alternative medicine use, and self-rated health in women with breast cancer

      2014, Explore: The Journal of Science and Healing
      Citation Excerpt :

      Research has shown that symptoms like pain, fatigue, shortness of breath, feelings of depression, and physical discomfort experienced in cancer are associated with poor self-rated health (SRH).21 Small reduction in SRH with increasing age has been observed in non-menopausal women and those undergoing natural menopausal transition.22 However, the association of cancer-related HF severity with SRH at the end of treatment and follow-up has not been studied.

    • Menopausal symptoms: Do life events predict severity of symptoms in peri- and post-menopause?

      2012, Maturitas
      Citation Excerpt :

      A higher BMI was also a significant predictor for several physical symptoms; hence women with a more elevated body weight would present more severe complaints in terms of aches and pain, numbness, urinary symptoms and body shape changes. It has been evidenced elsewhere that the menopausal status does not have an impact in self-rated health; however, modifications in BMI can predict a change in the perceived health status [34]. This data is relevant as an increase in weight can be reported around the menopause transition [35], and weight gain prevention should be targeted in order to prevent its impact not only in the body shape perception, but also in the perceived health status and specific physical symptoms that are, as demonstrated by our results, worsened with higher body weight.

    • Managing Menopausal Symptoms

      2006, Handbook of Models for Human Aging
    • Does the menopausal transition affect health-related quality of life?

      2005, American Journal of Medicine
      Citation Excerpt :

      The Melbourne Women’s Mid-life Health Project found no effect of change in menopausal status on perceived health. In fact, well-being increased across the transition.33,34 The Australian Longitudinal Study of Women’s Health reported that compared with women who remain premenopausal across a 2-year period, women who change from premenopausal to perimenopausal show declines in physical function but not in other indicators, such as pain and vitality.36

    View all citing articles on Scopus
    View full text